Homeward Bound Adirondacks — the sooner the better

June 29, 2011

The emotional and mental health cost to the nation's military personnel as a consequence of our long-term involvement in two wars is staggering. According to a Rand Corporation study, nearly one in five returning Iraq and Afghanistan veterans report post-traumatic stress disorder symptoms or indicators of major depression. The often debilitating symptoms of PTSD are grouped into three broad categories:

The effects of PTSD and other war-related emotional problems routinely spill over to veterans' families. Veterans Administration physician Evan Kanter states that mental health professionals are seeing "more marital problems, more behavioral problems in children, more family violence, and the potential for the generational transmission of violence."

A 2008 report by the American Psychological Association noted that multiple combat deployments increase the seriousness of mental health problems, contribute to alcohol and drug abuse, and are a factor in the disturbingly high numbers of military suicides. As of late 2008, approximately 60 percent of troops heading to Iraq were on their second, third or fourth deployment. U.S. Army Col. Carl Castro, director of a medical research program at Fort Detrick, Md., stated that by their second tour more than 25 percent of soldiers and Marines show signs of PTSD. For veterans exposed to heavy combat approximately 1 in 3 exhibit these symptoms. According to the Department of Veterans Affairs, in June 2010 more than 173,000 military personnel deployed in Iraq and Afghanistan had been diagnosed with PTSD. It's hard to imagine the mental/emotional condition of these men and women not deteriorating further under the stress of another war zone tour of duty.

A Rand study noted that while the Iraq and Afghanistan wars kill significantly fewer military personnel than conventional conflicts such as World Wars I and II, the present wars leave deeper psychological scars. Paul Sullivan, executive director of Veterans for Common Sense, notes that Iraq and Afghanistan troops are involved in "360-365 combat." That is, they are "completely surrounded by combat for one year." Sullivan notes that "nearly all of our soldiers are under fire, or being subjected to mortar rounds or roadside bombs, or witnessing the deaths of civilians or fellow soldiers."

One study found that National Guardsmen and reservists suffer emotionally in a different manner than active-duty soldiers and Marines. Research suggests that the former having been "called up" from established careers, are often married with children and are less prepared for combat than full-time soldiers and Marines. Typically older than full-time soldiers, National Guardsmen and reservists have more difficultly moving between their established home environment and a combat situation. Speaking of military reservists, Dr. Karen Seal of the University of California at San Francisco stated: "These are not people who live on a base, have a strong affiliation with a unit, or maybe ever saw themselves going overseas. ... The disparity between their expectations and what they were actually exposed to over there may create a lot of vulnerability to PTSD."

According to the U.S. Department of Defense, in 2010 almost 3,200 sexual assaults were reported by men and (mostly) women serving in all branches of the military. The DOD report states this figure comprised about 13.5 percent of the actual number of sexual assaults on active-duty military personnel last year. (If the DOD is correct, the true number of sexual assaults was approximately 23,700). In 2009, 22 percent of the approximately 53,000 female veterans who received care from the Department of Veterans Affairs stated they had been sexually harassed, sexually assaulted or raped while on active duty. Of these women, 52 percent received psychiatric care.

Speaking of military sexual-abuse victims, social worker Judith Orosz stated: "What is really troubling is that the sexual assaults are done by people who are supposed to have their back. People they are supposed to be able to trust. It's usually done by someone who knows them, someone in their unit and maybe even in a position of authority." Orosz notes that sexual abuse victims "leave the military with a lot of anger and feel like they can't trust anyone. It makes it very hard for them to hold a job."

Apart from high rates of sexual victimization, female combat veterans appear to experience similar levels of war-related stress and trauma as their male counterparts. This finding was based on a survey of 595 active-duty National Guard and reserve unit (340 women and 252 men) members in their first year home after a war-zone deployment. On average, the women in this study were three years younger then their male counterparts and more likely to be from racial/ethnic minority groups.

A study of almost 240,000 veterans who served in Iraq and/or Afghanistan between 2002 and 2008 found that only 9.5 percent of these individuals diagnosed with PTSD received the recommended course of treatment from a Veterans Administration health facility. For purposes of this study, treatment was defined as 10 weekly sessions over a 15-week period.

Dr. Karen Seal stated that while the research did not investigate the reasons for low treatment numbers, at least three factors might account for this finding:

-First, as a consequence of competing priorities for their time and energy (notably school, work and family obligations), young veterans may shun treatment.

-Second, living in rural areas often makes getting to urban VA hospitals a time-consuming activity.

-Third, the stigma of PTSD or mental-illness diagnosis is something many veterans wish to avoid at just about any cost. Seal notes that there's a great deal of distrust, avoidance and denial inherent in this disorder.

Some researchers are of the opinion that it might take years of dealing with behavioral and overall life problems before many veterans seek help. Psychologist Jim Sardo of the Department of Veterans Affairs in Portland, Ore., notes that the desire to move on with one's life and deny having war-related emotional problems is strong. It's not until veterans "lose the second job, get the second divorce or the third DUI that they begin to come in." Divorced, widowed or separated veterans are especially vulnerable to war-related emotional problems.

Between the invasion of Afghanistan in 2001 through the summer of 2009, 761 soldiers were killed in that war-torn country. During that same time period, 817 soldiers committed suicide. Between 2005 and 2009, one military service member took his or her life every 36 hours. Approximately one-third of confirmed suicides were committed by troops who had never been deployed to a combat zone. The remaining two-thirds were self-killings by individuals either in a war zone or upon returning home. According to one report, for every military suicide death at least five service personnel are hospitalized for attempting to end their lives.

Military suicide figures do not include deaths of war veterans who die in motor-vehicle accidents as a consequence of driving too fast and/or driving while intoxicated. It's reasonable to assume that some unknown number of these deaths were suicides, especially when the veteran was the only person in the car or truck and no other vehicle was involved.

According to a Time magazine story on military suicide, "The elephant in the room is the burden of repeated tours of combat duty on a soldier's battered psyche." Some research indicates that it takes as much as three years of "dwell time" (time spent at home between combat tours) for the stress of one year of combat to abate. Unfortunately, too few soldiers and Marines have the luxury of three years' dwell time between war-zone deployments.

Iraq War veteran Derek Giffin stated that "Americans can throw yellow ribbon magnets on their cars, wear American flag T-shirts and sing patriotic country music. The fact of the matter is that these things are of little consequence. None of them require any sacrifice." The requisite national sacrifice will be spending hundreds of billions of tax dollars over the next 60 to 70 years to care for hundreds of thousands of physically and psychologically wounded veterans.

Let us hope the Homeward Bound Adirondacks facility will be an important component in this lengthy healing process. The sooner it is up and running at full capacity, the better.

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P.S.: According to one estimate, the total cost of caring for wounded veterans over the course of their lifetimes will be greater than the cost of fighting the Iraq and Afghanistan wars. The National Priorities Project estimated that the cost of these wars will top $1.21 trillion on July 1.

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George J. Bryjak served with the First Marine Air Wing in Okinawa and Vietnam. He lives in Bloomingdale, retired after 24 years of teaching sociology as a professor at the University of San Diego.